The Canadian health care system of single-payer, socialized insurance is in trouble. Now, thanks to the ignorance and cowardice of our politicians, the American system is moving in the same direction.
A growing number of Canadian doctors, angry at irrational regulations, are refusing to accept new patients. As the national government slashes spending on medical care in order to reduce the deficit, local provinces are being forced to reduce medical staff. Pregnant women are sent to Detroit because no obstetricians are available. Specialists of all kinds are in short supply. The number of doctors who fled Canada for the United States last year (700) is more than double that of 10 years ago.(1)
Does any of this sound like the utopia of “universal coverage” Canadian politicians promised their constituents? Ask the people who have to wait 8 weeks for an MRI; or 4 months for heart bypass surgery; or 10 weeks for referral to any kind of specialist. The hard truth is that socialized medicine is destroying health care in Canada.
Most Americans do not understand that we are headed down a similar path in this country. The same mistaken economic and philosophical ideas that created socialized medicine in Canada are creating semi-socialized medicine in the United States today. The increase in managed care, bureaucracy, waiting lists, and expense of health care is the fault of our government. In its zeal to “compassionately” meet all of our health care needs and demands, our government is loving us to death.
How? To name just one problem, the government allows tax write-offs to businesses for health insurance, but not to individuals. Consequently, the vast majority of people utilize health insurance paid for by their employers. This means that the majority of health care is paid for by a third party. Doctors do not have to worry if they are charging too much; the health insurance company (or the government, in the case of the elderly and poor) will pick up the tab. Patients do not have to shop carefully for doctors and hospitals based on prices; they leave this responsibility to insurance companies and the government — who quite naturally respond by placing controls on the patient’s freedom of choice.
Imagine if a third party picked up the tab for any other commodity — such as groceries, rent, television sets, or automobiles. Sooner or later, prices would skyrocket because the consumer would feel no pressure or responsibility for spending carefully. This is precisely what has happened in the health care field over the last several decades. In the 1980’s, Medicare officials began to set price controls and regulations (“Diagnostic Related Groups,” or DRG’s) on the treatment of the elderly. In the 1990’s, private health insurance companies followed suit, by developing “health maintenance organizations” (HMO’s) and managed care bureaucracies that now drive most doctors and patients crazy with their red tape and arbitrary decisions about who may and may not receive treatment. Yet if private insurance companies had not taken these cost-saving steps, they would have gone out of business. Why? Because without some kind of controls, the price of medicine — like any other product or service provided for “free” — would have kept rising ever higher and higher, bankrupting the insurance companies who had to pay the bills. Had private insurance companies gone out of business, then the government would have taken over altogether and we would have exactly what the Canadians now have: single-payer, monopolistic, post-office style medical care.
Most Americans do not like the restrictions on choice and flexibility dictated by today’s managed care/HMO system. Increasingly, American patients encounter similar versions of what Canadians face: waiting lists for appointments, arbitrary treatment decisions made by bureaucrats rather than by physicians, and the threat of cutbacks in government programs such as Medicare in order to control the deficit. Today, in the absence of rational reforms, the United States teeters on the brink of a Canadian-like system.
Free Market Medicine: The Unknown Ideal
How did we get to this point? And, more importantly, how can we reverse course and prevent a plunge into the total disaster Canada now faces?
On one level, more people need to educate themselves about basic economics and come to understand that government interference in the medical marketplace has actually increased prices and harmed the doctor-patient relationship, rather than the reverse. Unhampered capitalism — not democratic socialism or welfare-state “liberalism” — would actually provide a more benevolent and more affordable health care environment. It would allow for the practice of the trader principle, in which doctors and patients (without the interference of third parties) could privately contract and negotiate for services and fees. Operating on the trader principle, doctors and patients could regain both the freedom and responsibility the government should never have taken away from them in the first place. In the marketplace, patients would be free to pursue any treatment they wanted. They would also be responsible for payment, thus making necessary the selection of the best price available among competing medical providers and hospital insurance carriers.
Doctors, likewise, would under capitalism be free to charge what they believed their services were worth; but they would also be responsible for competing in a marketplace where they risked losses if they charged significantly more than their competitors or more than what most people were willing to pay. Patients, shopping as informed consumers in the marketplace, would individually do the work of cost-cutting that the HMO’s and government bureaucrats currently do far less efficiently. Doctor and patient, each operating in his or her own rational self-interest, would experience the benevolence and good will that the Marxist-inspired welfare state never could have achieved. Just as capitalism (or, more specifically, the law of supply and demand) succeeds in making food and computers and automobiles and VCRs widely available at prices everyone can afford, so too with medicine and hospitalization insurance — if only the government would get out of the way and let the marketplace work.
It is true that in a free market there would be no price controls on medical professionals. But the law of supply and demand would operate to keep prices from rising beyond the point most people are able and willing to pay. If the cost of health care began to rise, and doctors started to make big profits, then more young men and women would rush to join the medical field. This would increase the number of health providers relative to the number of patients in need of medical services, thereby increasing competition and lowering the costs.
These basic principles of economics would work no differently in the medical marketplace than, for example, in a marketplace for televisions or microwave ovens or automobiles. The fact that medical treatment can be a matter of life or death does not change the basic nature of the economic principles in operation. On the contrary: the life or death nature of medical treatment makes it all the more urgent that the government leave the marketplace alone so it can function rationally.
The only alternative to today’s unpopular HMO and managed care bureaucracy, other than a movement towards a Canadian-like government takeover of medicine (which President Clinton and his wife unsuccessfully tried to impose on the United States in 1994), is the implementation of aggressive free market reforms. This means allowing all individuals to deduct one-hundred percent of their medical expenses (including health insurance premiums) from their taxes. This also means privatizing Medicare, as follows: (1) continuing the Medicare program for the current elderly, (2) phasing it out optionally (using tax incentives and medical savings accounts) for the middle-aged, and (3) telling young people that there will be no Medicare program for them and they must start saving for old age medical care on their own, with the help of tax incentives and medical savings accounts.(2) Medical savings accounts function like individual retirement accounts (IRAs), in which the individual saves money for medical care in a tax-free account.
It’s time to face facts: Medicare failed, even at achieving its own goals. Health care inflation exploded after the passage of Medicare, at higher rates than even its biggest opponents ever predicted. Accepting that Medicare failed presupposes an acceptance of reality. Young people need not be frightened by the reality of facing a future without Medicare; based on the government’s own projections, it’s going to be bankrupt in a few years anyway. Once doctors and hospitals are forced to compete with one another through competitive pricing, and have to answer directly to patients rather than to HMO’s or government bureaucrats, then costs will not be inflated like they are now. No, medical care will not be “free” in a free market. But it never truly was free in the first place. Remember that Medicare (like any socialized program) has to be paid for by somebody, whether through taxes, government rationing, HMO rationing, or some combination of all three. Nothing, in reality, is ever free.
Why Altruism Makes Socialized Medicine Inevitable
A more widespread understanding of how capitalism works will not be enough, however, to end today’s gridlock on the subject of health care. If it were, the collapse of communist economies throughout the world, and the failure of welfare-state democracies in Western Europe and Canada (not to mention America’s New Deal and Great Society welfare programs), would have resolved the debate once and for all.
Yet the debate is far from over.
In the United States, for example, liberals still insist that more government control over doctors and patients is needed, despite the evidence that government controls have failed. Conservatives, overwhelmed by guilt for their “political incorrectness,” likewise proceed, once in power, to expand the role of government in medicine even further. (Witness how the Republican-controlled Congress passed the Kennedy-Kassebaum bill in 1996, which essentially took over “private” health insurance companies by deciding whom they could and could not cover.)
Obviously, more deep-rooted philosophical and psychological issues must be identified and corrected before the trend toward a Canadian-like debacle can be reversed.
What are these issues? Responses to a Canadian survey on their health care crisis provides a significant clue. In this national survey, the majority of Canadians expressed the view that their socialized system, for all its problems, reflects their collective “generosity and compassion,” and that the existence of such a system gives them at least one clear claim to being “morally superior” to the United States.(3)
Imagine! A system which provides — indeed, even mandates — pain, suffering, inefficiency and stagnation can somehow be morally superior to a capitalistic system which (when allowed to function without interference) promotes competition, technological superiority, affordability, and respect for the dignity of the human individual.
In other words, it is supposedly better for everyone to have mediocre (or worse) medical care, as is the case in Canada, than it would be for some to have excellent care, some to have very good care, and everyone to have at least adequate care (through voluntary charity, if necessary), as would be the case under a system of laissez-faire (pure) capitalism.
What kind of moral code could make such an outrageous contradiction possible? By what standard of ethics can one say, “Well, our health care system is a mess, and many people even die needlessly, but at least there’s no evil profit or inequality here. We’d rather have people die than have prosperity, because prosperity means inequality and we cannot tolerate one iota of inequality.” The ethical code dominant in Canada, and increasingly dominant in the United States, is the code of altruism, or self-sacrifice: the idea that man’s greatest virtue is not productivity and enjoyment of life, but sacrifice, guilt, and the willingness to live solely for the sake of others. In the United States, this ethical code is totally at odds with our constitutional framework of individual rights, which states that each individual has the right to pursue life and happiness to the fullest, without the imposition of force by others.
Tragically, more and more Americans (as evidenced by the continued slide towards socialized medicine as well as other Big Government policies) are choosing the moral code of self-sacrifice over freedom and individual rights, simply because they feel too guilty to do otherwise. The code of altruism, after all, is thoroughly compatible with both the conservative Judeo-Christian ethic, which emphasizes self-sacrifice and minimizes the importance of life on earth (in favor of an afterlife), as well as Big Government liberalism and political correctness, which stresses the replacement of self-interest with sacrifice to the state (for the alleged good of society or some particular group in society).
Consequently, both liberals and conservatives feel too guilty to reverse the tide of altruism and socialism in the field of medicine, because to do so would mean violating their core ethical beliefs, however mistaken those beliefs prove to be.
How Nationalized Health Care Requires a War Against Facts and Reality
Even more fundamental issues than ethics add to the perseverance of socialized medicine, despite its notorious inefficiencies. Dr. Ted Rumble, an orthopedic surgeon in Toronto who is cooperating with the doctors’ protest movement in Canada, summed up one such issue very well: “The public doesn’t want a high quality medical system, it wants a free system.”(4) [italics added].
My own experience as a health professional suggests that Rumble’s statement applies as much to the United States as to Canada. Too many people resent the fact that they cannot have something for nothing, particularly in the case of medical care. In a way, who can blame them? As already pointed out, the government health policies make nearly everyone dependent on a third party — their employer, the insurance company, the government — for paying the medical bills.
Like the spoiled teenager who does not have to pay for his car, his gasoline, his clothes, or his education, many American adults feel that their medical care should just be available — somehow — and they should not even have to shop for it and compare prices like they feel the responsibility for doing in other areas of life. To make matters even worse, they are continuously told by the majority of their politicians (and politicians’ wives), their religious leaders, their psychotherapists, their professors, and their media experts that they have a right to health care on demand, as if health care grew on trees.
The strongest proponents of the “right” to health care, and of socialized policies in general, typically possess an underlying metaphysical belief that reality is somehow unfair and unjust. That because health care — or whatever else, for that matter — does not grow on trees, then “there ought to be a law” to make the desired commodity do the equivalent of growing on trees. Forcing us all to pretend that the nature of reality is other than what it is by having a President sign a feel-good bill is (at best) irrational and dishonest; it also never works, at least beyond the immediate range of the moment. (Of course, politicians are always delighted to participate in the charade, if it means advancing their short-term visibility and power). The simple fact remains that we cannot wish — or compel — “free” health care (or “free” anything) into existence.
Wendee Harper, a Canadian citizen angry because the government officials cannot seem to “reform” the socialized system (in other words, to somehow make the impossible “work”), offers a good illustration of this something-for-nothing mentality.(5) What kinds of “reforms” do the Wendee Harpers of the world, outraged by the inadequacies of their socialized system, usually support? Certainly not replacing the socialized system with a free market, which would be both morally and practically superior to the status quo. Instead, they go along with the government’s promotion of “utilization review” and “limiting” of “unnecessary” medical visits. In a word: rationing. Then they turn around and whine to the media that the government is rationing, instead of reforming, and wonder why they are distressed and confused.
Among academic and media elites there exists a far less innocent, yet characteristically stubborn, refusal to face the facts. What facts, exactly? The overwhelming evidence that socialism in all of its forms — communism, social democracy, national socialism, welfare state liberalism — has failed by every conceivable economic and moral indicator. Every time socialism is tried, it fails. It fails in exact proportion to the degree it is attempted. It fails both morally and economically. By its very nature, socialism has to fail because to accept its basic premises is to ignore the nature of reality.
The childish attachment to the idea of government medicine, in Canada and elsewhere, appears at times almost mystical. A New York Times reporter, for example, has described the “sacred place in the shrine of Canadian values” its citizens seem to hold for its disastrous medical system.(6) Former Prime Minister Margaret Thatcher of Great Britain, an unusually determined free market reformer, could not in the 1980’s make any real inroads against the English loyalty to their socialized medical system, despite its by then obvious failures.(7) To cite a more recent example in our own country, witness the hysterical rage many American political activists demonstrate if the possibility of cutting the rate of growth of the Medicare program — to say nothing of privatizing it altogether — is even mentioned.
Indeed, religious preachers have good reason to envy the reverence and unreasoned faith given to such bottomless pits as Medicare, Social Security, and Medicaid. While crossing oneself and kneeling at church may be increasingly out of vogue, it is now fashionable to do the equivalent at the feet of Congressmen and Presidents — who are expected to somehow provide for us what we are unwilling to provide for ourselves. How sad for a society founded on the principles of individualism, freedom, and self-reliance.
Evasion and Denial: The Final Break With Reality
Perhaps the ugliest demonstration of a fundamental idea which enables the dysfunctional and irrational Canadian health system to continue comes once again from the national survey of Canadian citizens.(8) Incredibly, the survey actually found people divided over whether doctors should tell patients that their treatment may not be the best available. (A similar debate is currently underway in the United States over whether HMO doctors should tell their patients when they are being denied superior treatment, or whether they should keep it a secret). Some Canadians responded that they would want to know so they could decide for themselves whether or not to go to the United States for treatment. But a significant number said they would have more peace of mind simply not knowing.
If you want to know the essence of psychological disorder, this is it. Psychologists call it “denial.” Denial means the false, irrational belief that “if I pretend something is not so, even in the presence of objective facts, it will not be so.” Philosophers call it the primacy of consciousness over reality. Ayn Rand, a philosopher who advocated the primacy of reality, referred to the phenomenon of willful evasion as the root of all evil. She defined evasion as “that nameless act which all of you practice, but struggle never to admit: the act of blanking out, the willful suspension of one’s consciousness, the refusal to think — not blindness, but the refusal to see; not ignorance, but the refusal to know. It is the act of unfocusing your mind and inducing an inner fog to escape the responsibility of judgment — on the unstated premise that a thing will not exist if only you refuse to identify it, that A will not be A so long as you do not pronounce the verdict ‘It is.'”(9)
If you want to know the psychological and ethical mechanism which maintains an irrational state of affairs — whether in the case of an alcoholic, abusive father whose problem everyone pretends does not exist, OR in the case of a child molester, whose activity is suspected within a family but nobody dares say so aloud, OR in the case of a medical system which leads to inefficiency and death but everyone pretends is “noble” — then evasion is it. Its essence is as follows: “If I shut my eyes and cover my ears, the problem will go away.” To the evader, consciousness supersedes reality. What he feels or wishes to be true is put ahead of what is true, and of what the evidence proves.
The ability of a human consciousness to rationally ascertain the facts of an objective reality is cynically dismissed by the evader. With this rejection of the ability to perceive objective reality comes the rationalization of behaviors ranging from lying to child abuse to political dictatorship. After all, if we lowly humans are unable to access reality and to think independently, then by what means do we assert our right to be free? Evasion, and its psychological cousin denial, do indeed represent the root of all evil, at least if the good is defined as human survival and happiness.
Doctors Fight Back: Medicine’s Last Chance
In the midst of the Canadian health care crisis (and the growing American one) there does exist one hopeful development not seen before, at least not on any organized and public scale: the protest of Canadian doctors against the socialized system. In Canada, more and more doctors are refusing to accept new referrals because of frustration over irrational government policies. They also pressured the government to take only 2.9 percent of their incomes for alleged “administrative costs” rather than the initially mandated 10 percent.(10) Even further, they have fought the government’s attempt to force urban Toronto doctors out of their practices into more rural areas farther north.
If Canadian physicians can find the courage to fight irrational and unjust government mandates, then American doctors — who at present still enjoy more freedom than their Canadian counterparts — should be able to muster the same courage. They should assert their moral right to sell their valued services in a free market, with no constraints by the government other than for objectively proven fraud and malpractice. They should give up the illusion of a free lunch offered by the Medicare program, and replace it with the much greater promise offered by the re-implementation of the trader principle into American medicine. They should recognize that patients (consumers), as well as doctors (suppliers), ultimately prosper better in a free market.
Furthermore, in a free society, voluntary generosity and kindness will never be against the law. People, in fact, are more likely to engage in individual acts of voluntary charity when the government does not take forty percent or more of their income to use for welfare state programs.
Too often we all forget that while in a free market there are no limits set on prices, there are also no limits or constraints on excellence, both in medical practice and the development of new technology. We also forget that Canada and other socialized systems only survive because they can lean on the United States both for supplemental care and the development and marketing of ever more sophisticated, life-saving technologies. If we want continued excellence in medicine, we have to be willing to pay for it. The Canadians don’t have to pay for it, because they can turn to the United States, which still permits a degree of capitalism in the area of medical technology. But what happens when the remaining remnants of the profit motive and free enterprise are eliminated from American medicine as well?
Capitalism, doctors must not be afraid to point out, delivers the goods — and because of its respect for the rights of the individual, it is the only proper, humane, and moral social system mankind has ever known. If anyone doubts this fact, contrast the results of semi-capitalism in the United States with the results of socialism or semi-socialism in Russia, Nazi Germany, Western Europe and Canada, and draw your own conclusions. There must be some reason why, when the chips are down, everyone comes to America for medical treatment unavailable elsewhere.
Great medical care would never have been possible in a society that did not respect the individual rights of doctors. When told about a patient’s refusal to pay for his services, Dr. Aaron Shutt, a fictitious surgeon in the CBS television series Chicago Hope, stated, “It’s not about money. It is about respect. Surgery is my art. It’s my craft. It’s mine to sell; it’s mine to give away. People. . .think it’s free for the taking. Well it’s not. And I’m going to do something about it.”
It’s time for all doctors to do something about it.
References
1. See The New York Times, “Doctor, What’s the Prognosis? Crisis for Canada” December 15, 1996
2. For more detailed proposals on privatizing the health care field, contact Americans for Free Choice in Medicine, 1525 Superior Ave., Suite 100, Newport Beach, CA 92663, http://www.afcm.org
3. The New York Times, December 15, 1996.
4. Ibid.
5. Ibid.
6. Ibid.
7. Margaret Thatcher, The Downing Street Years, 1979-90 (New York: Harper Collins, 1993), pp. 606-617.
8. The New York Times, December 15, 1996.
9. Ayn Rand, Atlas Shrugged (New York: Dutton, 1957; 1992 edition), p. 1017.
10. The New York Times, December 15, 1996.
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